Hospital discharge – why isn’t a picture worth 1000 words?

How do elderly patients and their caregivers leave the hospital?  Apparently with reams of paper that include post-hospital care instructions and medication lists.  In addition, a patient receives detailed verbal instructions from a nurse, perhaps for wound care, plus reminders to follow up with the doctor.  Note the 'best practice' outlined by the Agency for Healthcare Research and Quality -- more paper. Yet in the age of smartphone adoption by boomers – more than half of Pew responders were in the 35-44 age range, 39% were 55-64 – something seems odd about this document-intensive process. Consider a scenario in which an elderly person is going home, driven by a family member, or perhaps they are going to a rehab facility/nursing home.  

What if the post-hospital care is complex?  AARP’s Public Policy Institute’s report about the complex medical tasks done by family caregivers was instructive – unfortunately the instruction they received to do these tasks (for example, wound care, complex medication regimens) was not only incomplete, but no one professional role is accountable for both instruction and ongoing support at these tasks. Now consider family caregiver and technology use. Think about the role that YouTube videos play in our do-it-yourself world.  There’s even a YouTube video on how to upload a video to YouTube, never mind a video on how to change a dressing, care for a PICC line, a series of videos on living with various conditions – go ahead, search YouTube for a care practice you've always wondered about. Chances are good that a how-to-video is there. In fact, many of these videos seem to be generously posted by the patients themselves. But on sites like WebMD, how ironic -- the instructions are text, even as ads may be using full motion video.

The smartphone or tablet instructional video --up to the family?  Years ago, my mother was discharged back to a nursing home from a hospital stay following a painful bout of cellulitis from untreated lymphedema in her legs. The care in the hospital was wonderful – the specialists and therapists were experts on a complex wrapping care procedure that prevented recurrence. But no hospital staffer could go to the nursing home, so they said, to explain to staff how to do this specialty wrapping (never mind acquire the right supplies). And no one from the nursing home, so they said, could leave to visit the hospital to watch this new-to-them procedure. So my husband took his home video camera to the hospital and filmed the wrapping process step-by-step, then saved it on a standard video tape cassette. Discharged with a supply list, my mother went back to the nursing home – and to their credit, several nurses watched the video, training themselves to do the wrapping, and did it properly three times per week.  Problem solved.

In the age of smartphone videos all around – a personalized video for the patient. Today, leg wrapping videos are up on YouTube (albeit with a don’t-do-unless-under-care-of-physician nearly invisible warning). But let’s say the wound care for the discharged patient is unique – and the patient’s nurse can demonstrate the exact instructions, step-by-step.  Someone in the hospital, perhaps a family member, has a device that could create a short video, I just know it. Someone else knows how to upload it, and finally, someone in the person’s family knows how to view it. True, that’s a lot of one of wishing-and-hoping.  But hospitals could make it so:  upon admission, ask where will Mr. Smith go after his surgery?  Who are the contacts there?  Could someone there be able to take a look at a short video of discharge instructions?  Can you, the family member, create that short video when it is time for your father to leave? Does the volunteer network for that hospital include anyone who knows how to record and upload a short video?